OPHTE# / ,3 —r— _7076f' Harnett County Department of Public Health
PERMIT # dL_7 Operation Permit 22585
Pf' New Installation PT Septic Tank Er—Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: C'v /"'�J' u�-k �.
Name: (owner) 7f l ar on SUBDIVISION Cyznl ?"'d, LOT # 023
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms .3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: — Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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I. Performance:
System shall perform in accordance with Rule .1961.
11. Monitoring:
As required by Rule .1961.
III. Maintenance:
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No 5�r'
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑
D -Box ❑ Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications
for the sewa dispojs I system on the above captioned property.
Type of system: El
Conventional IZOther �p --o EZ Fly Septic Tank:
gallons Pump Tank: /OC) ® gallons
Subsurface
No. of exact length width of
depth of
Drainage Field
c itc te—1 es :-:! of each ditch dar feet ditches 3
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feet ditches l� inches
French Drain Required:
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Authorized State Agent �� � )A5 Date 9 113
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